Provider Demographics
NPI:1912798588
Name:ENNIS, ANGELA LAURA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LAURA
Last Name:ENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1416
Mailing Address - Country:US
Mailing Address - Phone:914-552-9183
Mailing Address - Fax:
Practice Address - Street 1:6 OLD TOMAHAWK STREET
Practice Address - Street 2:
Practice Address - City:GRANITE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:10527
Practice Address - Country:US
Practice Address - Phone:914-243-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist